Nerve Stimulation Enhances Task-Oriented Training in Chronic, Severe Motor Deficit After Stroke A Randomized Trial
Nerve Stimulation Enhances Task-Oriented Training in Chronic, Severe Motor Deficit After Stroke A Randomized Trial
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DOI：
10.1161/strokeaha.116.012671
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发表时间：
2016-07-01
期刊：
影响因子：
8.3
通讯作者：
Sawaki, Lumy
中科院分区：
文献类型：
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作者：
Carrico, Cheryl;Chelette, Kenneth C.;Sawaki, Lumy
背景和目的：一种基于感觉的干预，称为外周神经刺激，可以提高轻中度轻偏瘫中风幸存者的运动训练效果。需要进一步的研究，以确定这种配对的干预是否可以有好处的情况下，严重impairment（几乎没有主动运动）。方法与慢性，严重的中风后轻偏瘫（n=36）的主题随机接受10个日常会议的积极或假刺激（2小时）之前立即密集的任务导向的培训（4小时）。上肢运动功能采用Fugl-Meyer评定法（主要结果测量）、Wolf运动功能测试和行动研究手臂测试在基线、干预后即刻和1个月随访时。结果-干预后两组之间在Fugl-Meyer上的统计学显著差异有利于主动刺激组（95%置信区间[CI]，1.1-6.9; P=0.008）和1个月随访（95% CI，0.6-8.3; P=0.025），干预后Wolf运动功能测试干预后（95% CI，0.8-7.3; P= 0.015）和1个月随访时（95% CI，0.6-8.4; P= 0.025）的行动研究臂检验（95% CI，-0.21至-0.02; P= 0.020）。只有主动刺激条件与（1）1个月随访时所有结局的统计学显著组内获益相关，以及（2）干预后1个时间点1个结局的改善超过最小可检测变化以及最小临床显著差异。主动周围神经刺激与强化的任务导向训练配对可以显著改善严重受损的上肢运动功能。需要进一步的验证性研究，考虑更大的群体，以及更长的随访时间。
Background and Purpose-A sensory-based intervention called peripheral nerve stimulation can enhance outcomes of motor training for stroke survivors with mild-to-moderate hemiparesis. Further research is needed to establish whether this paired intervention can have benefit in cases of severe impairment (almost no active movement).Methods-Subjects with chronic, severe poststroke hemiparesis (n=36) were randomized to receive 10 daily sessions of either active or sham stimulation (2 hours) immediately preceding intensive task-oriented training (4 hours). Upper extremity movement function was assessed using Fugl-Meyer Assessment (primary outcome measure), Wolf Motor Function Test, and Action Research Arm Test at baseline, immediately post intervention and at 1-month follow-up.Results-Statistically significant difference between groups favored the active stimulation group on Fugl-Meyer at postintervention (95% confidence interval [CI], 1.1-6.9; P=0.008) and 1-month follow-up (95% CI, 0.6-8.3; P=0.025), Wolf Motor Function Test at postintervention (95% CI, -0.21 to -0.02; P=0.020), and Action Research Arm Test at postintervention (95% CI, 0.8-7.3; P=0.015) and 1-month follow-up (95% CI, 0.6-8.4; P=0.025). Only the active stimulation condition was associated with (1) statistically significant within-group benefit on all outcomes at 1-month follow-up and (2) improvement exceeding minimal detectable change, as well as minimal clinically significant difference, on 1 outcomes at 1 time points after intervention.Conclusions-After stroke, active peripheral nerve stimulation paired with intensive task-oriented training can effect significant improvement in severely impaired upper extremity movement function. Further confirmatory studies that consider a larger group, as well as longer follow-up, are needed.